Compliant Utilization and Billing

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Start Time:12:00 AM
End Time:12:00 AM
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Additional Information

Provided by MHA Health Institute
Health Institute

Date & Time

Thursday, July 13, 2017   
10 - 11:30 a.m.

Register on or before Thursday, July 6, to ensure delivery of instructional materials.

MHA members — $225
Nonmembers — $275

The webinar registration fee is for one phone line connection. Additional phone line connections each will be charged a registration fee. Multiple participants on the same connection is encouraged. Get more value by inviting colleagues to join you!

This webinar is being offered at a reduced registration fee to MHA-member hospitals because of a contribution from MHA Management Services Corporation.


coding staff, billing and claims transaction staff, chargemaster coordinators, clinic managers, financial analysts, compliance staff, nurse practitioners, physician’s assistants, clinical nurse specialist, speech-language pathologists, nurse midwives, physicians and other interested personnel

The following program content was provided by the speaker.


What kind of requirements exist for nurse practitioners, physician assistants and clinical nurse specialists, and how do they relate to physicians? Are there special compliance issues that affect NPs, PAs and CNSs? Are there special concerns for critical access hospitals relative to NPs, PAs and CNSs? These questions and more will be addressed during the webinar.


  • review the range and type of non-physician practitioners that are used by hospitals, CAHs and clinics of all types
  • discuss NPs, PAs and CNSs, and their use by hospitals and clinics
  • review how non-physician practitioners are reimbursed for services under Medicare and other private third-party payers
  • discuss proper coding conventions and utilization of modifiers for NPs, PAs and CNSs
  • discuss the difference between “freestanding” situations and “provider-based” situations
  • review the interplay between the Medicare physician fee schedule and ambulatory payment classifications for non-physician reimbursement in different settings
  • recall the concept of “incident-to” and the differences in interpretation between physician/clinic situations and hospital situations
  • review the physician supervision requirements under Medicare for NPs, PAs and CNSs
  • define the proper use of shared/joint visits
  • review several case studies illustrating the coding, billing and claims filing process and differences in payment
  • review the important compliance issues, including the place of service, surrounding the use of NPPs
  • review compliance issues relative to CAHs and RHCs


  • Non-Physician Practitioner Overview
    • types of NPPs
    • Medicare versus state law requirements
    • utilization of NPs, PAs, CNSs
    • reimbursement issues
    • compliance issues
    • hospitals versus CAHs versus clinics
  • Professional Versus Technical Component Payment
    • resource-based relative value scale review
      • relative values
      • place of service differential
      • examples – reduced payment for NPPs
    • APC versus cost-based reimbursement
    • freestanding versus provider-based status
    • private practice for NPPs
    • Medicare enrollment
  • Types of Non-Physician Practitioner/Providers
    • template for assessment
    • physician assistants
    • nurse practitioners
    • clinical nurse specialists
  • Non-Physician Practitioners – Compliance
    • CFR guidance
    • state level laws and scope of practice
    • telehealth/telemedicine
    • special CAH conditions of participation
    • assistant at surgery
    • the ‘‘incident-to” concept
      • freestanding situation
      • provider-based situation
    • place of service considerations
    • collaborative agreements and other requirements
    • shared/joint services with physicians
    • physician supervision requirements
    • CMS-855 enrollment issues
  • Examples and Case Studies
    • nurse practitioner in medical practice
    • physician’s assistant in provider-based clinic
    • clinical nurse specialist in hospital setting
    • nurse practitioner at urgent care center
  • Sources for Further Information


Duane C. Abbey
Abbey & Abbey Consultants, Inc.
Ames, Iowa

Duane Abbey is a management consultant and president of Abbey & Abbey Consultants, Inc., based in Ames, Iowa. For more than 20 years, Abbey & Abbey Consultants, Inc., has provided health care consulting services to hospitals, hospital systems, physicians, medical clinics and integrated delivery systems. In addition to consulting, Abbey has been an invited presenter for hospital associations, medical societies and other groups. He also has published articles and books on health care topics. Abbey earned his graduate degrees from the University of Notre Dame, in South Bend, Indiana, and Iowa State University, in Ames.